A major theme that seems to have emerged in this discussion is the lack of autonomy, at all levels of training and practice, as a cause of physician burnout. I recently read "Drive" by David Pink, which discusses ways to increase performance and satisfaction, although mainly from the perspective of a business owner. Pink asserts that there are four essential aspects of autonomy: "task" (what people do), "time" (when they do it), "technique" (how they do it), and "team" (who they do it with). It seems like there are system-level restrictions all aspects of autonomy in medicine (for instance, you have to do administrative work, you have to complete notes within a certain timeframe, you have to practice with respect to pre-specified quality metrics, and you have to work in large and disorganized teams). I do wonder, however, if there are ways to increase autonomy on more of a day-to-day level? For instance, on some services, would it be possible to pick your team on an inpatient service? And would such a small gain in autonomy have any effect on burnout?
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